FINAL APPROACH DESCENT PHASE
SITREP 14 In the air SMOKE!
It happened on 12 April 1966, the details still seem indelibly stamped on my memory, but it is hard to be sure how much of what I remember is as it really was, or how much is what I have rationalised afterwards. What I do know is that it altered my whole attitude to aviation, as I will explain.
During my 36 years of flying I only had two searing experiences; one was the smoke incident in the right hand seat of a Super VC-10, G-ASGC, which is now preserved at the Duxford museum. The other, at the opposite end of the spectrum, was at my fleet manager’s desk in ‘TBA’ (BA Technical Block A at LHR) dealing with the aftermath of a B747 incident.
Although I have recounted the smoke incident to a few people at various times, I have never revealed all the surrounding details and I have never written about it, so what I will now tell you is the whole story as I best remember it, some details of which are personal, and some of more general interest.
We were rostered for the standard trip LHR-JFK (night off), JFK-PWK-MAN (2 nights off), MAN-PWK-JFK (night off), JFK-LHR. The crew consisted of the captain who was wartime RAF (bombers I think), the senior first officer, also ex-RAF, he had done national service followed I think by a short service commission (I know he had been on Hunters at one time), the senior engineer officer (whose background I can’t remember) and myself - the junior first officer (ex-Hamble with all of three and a half years in BOAC), and six cabin crew. As was usual in those days, I navigated the outbound Atlantic sector and was due to sit in the right hand seat on the return leg.
On our first night in New York, and this is eerie, I was discussing flying experiences with the SFO in a bar and saying that I was still wet behind the years and nothing much had ever happened to me. He described an incident he had had in a Hunter when flying at very low level (I think off the Dutch coast) when he suffered a bird strike which had broken through his windscreen, knocking him out. He came to, to find the aircraft climbing and, surprisingly, everything under control despite being cut around the face and head. Evidently the normal procedure, when low flying, was to trim the aircraft very slightly nose up so that in the event of an incident or some slight inattention, the aircraft would fly itself in the right direction away from the ground – and he was very thankful that he had done that. I can clearly remember saying at some stage during the conversation that I had never had any kind of emergency or anything frightening happen to me in an aircraft and that one part of me hoped it would happen one day, just so that I would know how I would react and whether I could cope. As events turned out….well, talk about tempting fate! I am not superstitious but I never said such foolish things ever again.
Next evening we made a normal max weight take-off from 31L, turning out over Jamaica Bay and climbing to altitude along the southern shore of Long Island, to head off towards Newfoundland and the Atlantic. As I remember it, the night was reasonably clear, dry and without any significant weather problems. At some stage during the climb we started to smell a hot burning smell that seemed slightly electrical, but none of us could really put our finger on it. The SFO went back to see if the stewardess had burnt the first class hot towels, a not unusual occurrence as they used to be warmed up in the galley oven and sometimes forgotten – but that was not the cause. The smell became slightly stronger and I think the engineer went back to see if there was anything wrong in the galley because it really did smell electrical and we also looked around the cockpit – but there was nothing. I can clearly remember switching off the aileron upset at 24,000 feet, so I know that we were just above that altitude when it happened. Suddenly, from all around, from under the instrument panel, from above my head, from behind my seat thick smoke poured out completely blocking all visibility. I think someone shouted: “Get on oxygen” but I really can’t remember, nor can I remember even putting my oxygen mask on, but I think I must have because I remember fiddling around with the plastic flap down by my right leg where the mask was kept, but I may have given up because I couldn’t find it – I really don’t know. The next thing was the autopilot coming out; I remember the aural warning and the captain shouting that we were on fire and must make an emergency descent and depressurise. Whether he disengaged the autopilot or it fell out I will never know. At this stage visibility in the cockpit was down to about six inches.
Then the engineer shouted that he thought it would be a good idea to kill the radio switches, and I can clearly remember thinking what a good idea, and I think the captain said yes, do it. BIG MISTAKE … We were all ex-‘Britannias’, and on the Britannia 312, the radios were in the back of the flight deck and the smoke drill involved switching off the radio switches. I cannot remember what else (if anything) was switched off by this action on the Britannia, but on the VC-10 the radios were in the radio bay below the floor, where they couldn’t make smoke in the cockpit AND in addition to switching off the radios, these switches also switched off the main flight instruments (Horizon, Compass, Altimeter).
Everything was happening very fast, I have no idea of the timescales, but the next thing I was aware of was the captain shouting that he could not see his flight instruments and the high speed warning horn sounding off. Whether the sequence was in the order I have described or whether the captain shouted that he could not see his instruments before the radio switches were switched off, or whether it was all at the same time I do not know. What I do know is that I put my chin on the top of the control column and pressed my forehead hard against the coaming and could just see the horizon and the other instruments but only one at a time as I moved my head around. I can clearly remember seeing the warning flags on the horizon, on the compass and on the altimeter but I did not associate these with having switched off the radio master switches. What did chill me was that the altimeter was stuck at 18,000ft., and the VSI pointer was on the stops pointing down at over 6000ft/min. I remember thinking there is going to be a bloody great bang in a moment and then thinking you can’t just sit there – you have got to do something. I shouted that I could see my instruments and started to try to fly the aircraft too. And that was when good Hamble training kicked in.
At Hamble we had all done lots of recoveries from unusual attitudes, on instruments, on limited panel, in Chipmunks. By this time I could see the airspeed needle somewhere on the right hand side of the ASI, I could see the VSI needle on the
stops, and I could see the turn and slip (I think it must have been showing a hard left turn because in my memory all I can remember is turning the control wheel to the right) and realising that we were in a spiral dive. I shouted: “I have it, I can see my instruments” but I doubt very much that the captain relinquished control, so I suppose we both flew it out. I knew I first had to get the turn needle into the centre, and only then pull back until the VSI started to come back to a normal reading, and to very carefully check the airspeed so as not to overdo it. I don’t remember the high speed warning horn stopping, but it must have. Gradually the smoke began to clear and I became aware of the SFO lying across the centre console and that we were climbing gently (he said later that he had had his head up against the standby horizon so that he could call out the attitude, but I was totally unaware of that). He also told me that the G forces had pinned him there but, again, I don’t remember any G forces.
At some stage the engineer must have switched on the radio master switches and I became aware of ATC calling us. I can’t remember what they were saying, but my first words on the R/T were; “We’re on fire and we can’t see a bloody thing”. As things gradually returned to normal I realised we were climbing (I think through somewhere around 20,000ft) and were heading west, in the opposite direction. How low we went or how fast we went, I have no idea. Neither could we find out later; it was before the days of flight recorders.
The captain asked for an immediate return and that we would land overweight without dumping fuel because we were still convinced we had a fire somewhere on board. ATC were excellent, they had cleared all the other traffic off the frequency, they asked about the nature of the problem, and I can remember saying something about smoke and that we thought we were on fire, and they gave us vectors to 31L that were exactly right – neither too rushed nor too long, I felt so grateful to that controller. The approach and landing was normal, but at a suitably faster speed. The aircraft stopped with lots of runway length to spare, I can remember being surprised at how much runway was left in front of us. We were then surrounded by fire engines and I think the captain must have talked to them about signs of fire, I cannot remember any details other than it was decided to taxi in without evacuating the passengers.
When on stand, the local manager and ground engineer piled onto the flight deck and there were a lot of other people around, but I do not remember much as I think I was just doing a normal shut down checklist probably taking refuge in a normal activity. The passengers were offloaded, one was a priest who made a sign of the cross and blessed us; another man was on his first flight and said he would never fly again – I don’t blame him.
Then I think we just sat there while the captain and manager decided what to do next. I do remember someone giving us a bottle of whisky saying we might need it, and we all got off and went back to the hotel doing all the usual things one does after a flight but in a kind of blur. That night I think we sunk several bottles in the hotel!
Next morning I went for a walk in Central Park and have never seen the world looking so beautiful before or since.
As I write this, I cannot check my logbooks because they are still in a packing case somewhere; we have recently moved house. But we then operated the normal schedule to Manchester, I think the very next day. In Manchester the captain went down to London to explain the incident and we continued the rest of the trip itinerary, but with a new captain. I think we all behaved and flew normally, and it wasn’t until I got home that I let go. I don’t think I was given any time off and neither did I ask for it. Of course, the rumours started flying round the fleet and at slips I heard people talking about it, not knowing that I had been one of the crew, and they had some hard things to say about what we had done. It hurt, because I knew that we had made some dreadful mistakes, but I didn’t let on.
So what were the lessons? On the plus side, I had discovered that I could act rationally when in extremis, and that I found comforting. On the minus side, I knew that we had done lots of things wrong and I found that very humiliating; it took quite a time to regain my confidence, not because I had been frightened (which I had been) but because I knew that I did not know enough about flying in general and my aircraft in particular. And I vowed never to be found wanting again, perhaps I even became a little obsessive. I read avidly, I read manuals, I asked questions of instructors, I tried to find out as much as I could about flying and I wanted to know the derivation of everything; and it was that which probably led me to become first a navigation instructor and then a simulator instructor, eventually leading to a whole career in training and management.
Regarding the incident itself, the engineering investigation found that an oil seal in the Godfrey blower (an engine driven compressor providing air to the cabin pressurisation system – the VC-10 did not use engine bleed air) had failed so that all the gearbox oil had leaked into the compressor itself, had been vaporised, and pumped straight into the cabin.
Fortunately, it was non-toxic and non-irritating; otherwise I don’t think we would have regained control. The flight operations investigation (which involved only the captain and engineer) found that we had done a good job and we were all presented with a commendation by the chairman, Sir Giles Guthrie. BUT I knew in my heart that we had not deserved it, we had made too many mistakes, and it was that that upset me and drove me on. We had rushed into action too fast, we had not left the autopilot engaged for long enough, and we had reverted to previous type and switched off the radio master switches without realising the consequences.
The main flying lesson for me was: - don’t rush into action, stop, think, analyse and only then do something. With hindsight it is easy to see that had we just sat on our hands and done nothing at all, the oil would all have been vaporised, blown through the cabin, and the smoke would eventually have cleared by itself. Obviously, in the situation we had just experienced we had to act fast. But in most emergencies there is usually time, maybe only a few seconds or minutes, to pause and analyse before leaping into action. The next lesson was to know much more about the aircraft and its systems. I should have known not to switch-off the radio master switches, because they not only disabled the main flight instruments but also the autopilot. That action, more than anything else, turned a minor incident into a near accident.
COMMENT
The more I continued to fly the more I never wanted again to be in the position where I could be suddenly caught out. As a navigation instructor, I used to ask my pupils how they would tackle certain situations that I would dream up for them. I tried to be careful to explain that I was not trying to catch them out, but merely to extend their knowledge, and mine. I would join them in the manuals to work through some bizarre problem that l had dreamt up. I used to do the same on the simulator when I became a simulator instructor and had some spare time. Sometimes I did it with a pupil and sometimes I did it on my own. In retrospect I just hope that my pupils did not see my obsessive ‘what ifs’ as threatening but instead, a real desire to seek the truth. When I became a captain I would pass the time in the cruise thinking up problems for myself, deciding how I would tackle them and then check to see if I was correct by going through the manuals. I often wonder now what my crews must have thought.
As I got to know myself better I found that I was not so good at some handling items, for example throughout my career I always sweated on three engine ILS and NDB approaches, when others could fly them like a dream. But I compensated by knowing my way around the manuals and developing what I think was a thorough understanding of what was necessary for making good tactical decisions. But of course that still did not prevent me from making mistakes.
I also became very interested in why people made mistakes and what were the real causes of accidents. So much was just put down to pilot error, which at the superficial level is true, but the really interesting bit is to try to find out why human beings make mistakes. Remember, this was still at the time when training departments viewed mistakes as heinous crimes and not as learning opportunities. I read up on the psychology of visual perception and found out how easy it is for the human animal to misperceive and be misled by visual illusions. I read up on stress and fear to find out more about why and how humans react the way they do and found out how human perception narrows down as stress and workload builds up. I read the various books on human error and how we are all prone to false hypotheses – and that was the really interesting one. If something happens and you accept a false hypothesis, and you are under stress, it is very probable that you will continue to act upon that hypothesis and not be able to change it. You will then carry out a set of actions which may well be the right ones for the hypothesis but not appropriate for the actual situation.
QUESTIONS
1. Would it have been a good idea for the captain to have called the flight deck crew together after the incident and discussed the whole episode?
2. Was it a good idea for the crew to continue to operate the schedule?
3. Could stress have developed to the extent that it might have impaired the safety of the subsequent sectors?
4. What would you do to reduce stress in a crew member?
5. What do you know about stress?
6. Where could you learn more about stress and its symptoms?
WHAT CAN ONE LEARN FROM THIS?
As a result, I came to accept a set of rules which I tried to inject into the instructor courses and into our training routines. I think they are these:-
1. Modern aircraft are easy to fly, they are very reliable and have good handling characteristics, therein lies the danger. It is all too easy to be unprepared for the rare occasions when it all goes wrong and you really have to fight for your life.
2. Other than for smoke fire and noxious fumes situations, most events do not require instant action. The ones that do are regularly practised on the simulator so that they become routine. Such things as rejected take-off, engine failure after V1 and wind-shear recovery are good examples where an instant and correct response is required.
2. Other than for smoke fire and noxious fumes situations, most events do not require instant action. The ones that do are regularly practised on the simulator so that they become routine. Such things as rejected take-off, engine failure after V1 and wind-shear recovery are good examples where an instant and correct response is required.